9 Common Reasons Workers’ Compensation Claims Are Denied In Pennsylvania

When you have suffered a work-related illness or injury, you need your workers’ compensation benefits to help support you and your loved ones while you recover. This is why it is so disheartening and overwhelming when your claim for benefits is denied. Fortunately, the attorneys at Vanasse Law, LLC, can help you appeal your denial so that you can receive the benefits to which you are entitled. Reach out today to speak with a Lancaster workplace accident attorney.

The following are common reasons why workers’ compensation claims are denied. 

#1 You Have A Pre-Existing Condition

You may have your claim denied because the insurer maintains that the condition for which you are making the claim existed prior to when the accident or injury related to your employment occurred. However, the fact that you have suffered from the condition before is not an automatic bar to benefits, and if your claim is denied, you should speak with a Lancaster workplace accident attorney.   

#2 You Missed Deadlines

There are important deadlines throughout the claims process which must be met or your claim for benefits may be denied. For example, while you should report your injury to your employer within 21 days to receive retroactive benefits, a failure to report it within 120 days from the date of injury may result in your inability to collect any workers’ compensation benefits. Another example would be if you miss the time frame available to file your claim, which typically is three years from the date of injury. 

It is always a good idea to speak with a Lancaster workplace accident attorney as soon as possible after your injury occurs. There are certain deadlines and time frames with which you must comply or you will not be able to collect your workers’ compensation benefits.   

#3 You Did Not Provide Enough Proof or Information

The insurer will require certain information regarding you and your injury before approving your claim for workers’ comp benefits. This may include an accident report, statement of wages, and medical records. Failure to provide the documentation needed to verify your claim, including proof of the injury suffered, can result in the denial of your claim for workers’ compensation benefits. 

#4 You Did Not Receive Treatment From An Approved Medical Provider

Within the first 90 days after your injury occurs, you must seek medical care from doctors that have been approved by your employer. If you seek care from a physician that has not been approved by your employer, you risk having the cost of that care denied by your workers’ comp insurer. 

After 90 days you should be able to see a medical provider that you choose even if they are not considered approved by your employer. Just bear in mind that the medical care must be necessary and actually related to the work injury. Questions about coverage can be addressed with your Lancaster workplace accident attorney.

#5 Your Injury Did Not Happen in the Scope or Course of Your Employment

Your injury must have actually occurred in the course and scope of your employment. In other words, if you trip and break your ankle while running in your neighborhood, you will not be able to collect workers’ compensation benefits for your injury. However, if you are walking down the hall at your place of business, trip on a power cord, and break your ankle, that injury should be covered by workers’ compensation.

However, it is important to note that if you are injured while not actually at your place of business but while you are working, you should be eligible for benefits. For example, if your employer sends you to the store to pick up office supplies and you are rear-ended on the way back to the office, you should be eligible for workers’ comp benefits for any injuries you sustain.  

#6 The Insurer Does Not Believe You

Sometimes the insurer will deny your claim for benefits because they do not believe you are entitled to them. They may feel that your story of what happened does not make sense or that the medical reports are incongruent with how you say the injury occurred. A lack of witnesses or any corroborating evidence of the injury can also lead to a denial of benefits. Denials, for this reason, are more common when you have delayed reporting your injury to your employer or filing your claim for benefits.  

#7 Your Employer Disputes Your Claim

If your employer disputes your injury or that your injury should be covered, the insurer may deny your claim for benefits. Your employer may have video footage or witnesses that do not support your version of events. Also, employers sometimes dispute claims because they do not want an increase in premiums. If your employer wrongfully disputes your claim, contact a Lancaster workplace accident attorney at Vanasse Law, LLC.

#8 You Were Engaged In An Illegal or Irresponsible Activity

Your work-related injury or illness claim will certainly be denied if it occurred because you were engaging in an illegal activity. For example, if you are intoxicated or high on drugs when you are injured, your injury may not be covered by workers’ comp benefits. The same can be said if you are injured while engaging in an activity that is not related to your employment or if you ignored established safety protocols. 

#9 You Are Not A Covered Employee

Not all workers are eligible to receive workers’ compensation benefits in Pennsylvania. Independent contractors are one group that is excluded. If you have concerns about your ability to receive workers’ compensation benefits, it is best to reach out to a Lancaster workplace accident attorney.

Be Sure To Have A Lancaster Workplace Accident Attorney By Your Side

If your claim for benefits has been denied, you need a Lancaster workplace accident attorney to help you with your appeal. At Vanasse Law, LLC, we are experienced attorneys that focus our practice on representing injured workers in obtaining their workers’ comp benefits. We may be reached by calling 717-397-1010 or via our contact page.